When the baby pays the price: Navigating the rigours of breastfeeding at work

Breastfeeding at work remains one of the major challenges working mothers in Rwanda are grappling with, with many organisations and workplaces yet to put in place facilities that can enable breastfeeding during working hours. At the recent Africa Food Systems Forum (AFS Forum 2024), several discussions focused on how Malnutrition is costing Africa billions of dollars due to the higher healthcare costs and loss of productivity. Stunting and other conditions that are a result of micronutrient deficiencies are a silent killer of children- and they mostly start when there is no sufficient breastfeeding, especially in the first six months of life of a child. It is a challenge many mothers who have to work to feed their families are struggling with, many choosing to abandon breastfeeding and resort to giving their babies formula milk and other foods as an alternative to breastfeeding. Emeritha Muhorakeye, 33, gave up on breastfeeding her two children at five and six months, respectively, because she could not balance her work and breastfeeding, yet her workplace does not provide special facilities to enable her to breastfeed. “After my three months maternity leave, I could not sustain breastfeeding because of the difficulties of movement between my home in Masizi and my workplace in town,” says Muhorakeye. Despite being a health worker herself, Muhorakeye says it became practically impossible to continue breastfeeding when she resumed work because she could not afford moving between her workplace and work to breastfeed. “I normally get a one-hour break but it is not enough for me to move from town to Masizi and back. At first, I tried to pump and preserve the breast milk but we had no specialised facility to keep the milk,” she says. Working in a hospital, Muhorakeye says she gets little or no time to pay attention to breastfeeding, because often they have a lot of patients who keep her busy while her employer is yet to consider putting in place a breastfeeding room. It is a challenge Muhorakeye says many of her colleagues and other working mothers she knows face, many not being able to have a place to breastfeed, especially those who operate in town and the environment is not conducive for babies. Last month, on August 7, Rwanda joined the rest of the world to mark World Breastfeeding Week, which was celebrated under the theme, Closing the Gap: Breastfeeding Support for All.” It was noted that while Rwanda has taken and continues to take proactive steps to ensure that every mother and child has access to the support they need for optimal breastfeeding practices, some gaps that need to be addressed remain. On August 8, the Rwandan government launched a month-long campaign dedicated to promoting and enhancing breastfeeding practices across the nation, which ended September 7. ALSO READ: Seven key changes in Rwanda’s new maternity leave law For the past four weeks, concerned institutions, including the National Child Development Agency (NCDA) and stakeholders such as UNICEF, have been raising awareness about the benefits of breastfeeding. The drive, among other things, focused on dispelling myths around breastfeeding, addressing challenges that mothers face when it comes to breastfeeding, by providing education and resources, with the aim of bridging the gaps in breastfeeding support. A tough choice to make For Emma Marie Uwurukundo, a fruit and vegetable trader, exclusive breastfeeding for her was a far-fetched dream, because the work she does requires her to move from one place to another, mainly crowded markets, which make it impossible to exclusively breastfeed. While the government campaign encourages parents and the community to adopt optimal breastfeeding practices, with a focus on initiating breastfeeding within the first six months of life, for Uwurukundo, who has no annual leave, the struggle to sustain breastfeeding is real. However, if the markets she operates in had breastfeeding rooms, she would be taking her baby because she understands the importance of breastfeeding for both maternal and child health. The Rwandan government has committed to giving every child the best start in life, with breastfeeding as the main foundation of a healthy future. The World Health Organization (WHO) considers breastfeeding one of the most cost-effective ways to reduce childhood morbidity. While breastfeeding is one of the most effective ways to ensure child health and survival, the WHO reports that fewer than half of infants under six months old are exclusively breastfed. According to the Demographic and Health Survey (DHS) 2019-2020 shows that exclusive breastfeeding in the first six months without any other formula decreased from 87.3 per cent in 2015 to 80.9 per cent in 2020. In Rwanda, according to UNICEF, overall EBF (Exclusive Breast Feeding) rates have remained high above 80 percent since the early 1990s though there’s significant decline in the last decade from 87.3 percent in 2015 to 80.9 percent in 2020. “It is likely due to the decline of exclusive breastfeeding at 4-5 months from 80.8 percent in 2015 to 68.1 percent in 2020. Mothers may start introducing the complementary foods earlier at 4-5 months, possibly linked to the time they’ve to go back to work,” says Samson Desie, a Nutrition Specialist at UNICEF Rwanda. Desie says there is a need for continued awareness to emphasise the importance of workplace breastfeeding and appropriate maternity leave benefits. According to the UNICEF official, the introduction of solid, semisolid, soft foods at 6-8 months has increased from 56.7 percent in 2015 to 81.4 percent in 2020, which calls for the need to enhance and strengthen Maternal Infant and Young Child Nutrition (MIYCN) counselling. Desie said that UNICEF is actively involved with the Government of Rwanda in promoting breastfeeding in the country, through various initiatives and programs undertaken with institutions like NCDA and RBC, aimed at improving child health and nutrition. The UN agency works with the government to drive human centred design social and behavioural change communication to raise awareness about the benefits of breastfeeding through campaigns, community outreach programs like peer-to-peer approach, and MIYCN educational/communication and counselling materials. In the area of capacity development, Desie said UNICEF provides training to healthcare providers, including doctors, nurses, and community health workers, on breastfeeding techniques and counselling. “This ensures that mothers receive accurate and consistent information and support. Moreover, UNICEF works with community health workers and local leaders to establish breastfeeding support groups. These groups provide peer support and practical advice to mothers in their communities,” “UNICEF collaborates with the government to monitor breastfeeding rates and practices. This helps to identify areas where additional support and intervention are needed,” he said. In general, UNICEF promotes exclusive breastfeeding for the first six months of life, followed by continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. As part of its broader nutrition programs, UNICEF integrates breastfeeding promotion into efforts to combat malnutrition and improve overall child health. UNICEF also advocates for strong policies and legislation that protect and promote breastfeeding, including supporting maternity leave policies and ensuring that workplaces provide breastfeeding-friendly environments. The support in policy and legislative environment includes technical and financial support to NCDA-MIGEPROF and The Rwandan Women Parliamentary Forum. UNICEF collaborates with NCDA to encourage public offices to have a breastfeeding and child friendly space, by providing the design, training and some of the supplies for those who take an active step forward in establishing these corners in their offices. By addressing both the healthcare and socio-cultural aspects of breastfeeding, UNICEF aims to create a supportive environment where mothers can successfully breastfeed their children, thereby improving the health and well-being of infants and young children in Rwanda. UNICEF emphasises that breastfeeding is a core child survival intervention: It protects babies from common infectious diseases and boosts children’s immune systems, providing the key nutrients they need to grow and develop to their full potential. “Babies who are not breastfed are 14 times more likely to die before they reach their first birthday than babies who are exclusively breastfed for the first six months of life,” “To improve child survival and promote healthy growth and development, UNICEF recommends exclusive breastfeeding for the first six months of a baby’s life, followed by the introduction of complementary foods alongside continued breastfeeding until at least two years of age or beyond,” Desie said. UNICEF equally recommends increasing maternity leave for working mothers because legally guaranteed maternity leave is essential for supporting breastfeeding because it enables new mothers to take time off work while retaining economic and job security. “Government action is needed to support women in overcoming social, political and economic barriers to achieving their breastfeeding goals,” he further argues. Corporate companies taking the lead Several corporate companies, including banks, have taken the lead, to make it easy for working mothers to nurse their children at work, but putting in place facilities that enable mothers to breastfeed during working hours. Among them are Bank of Kigali (BK) which inaugurated its ‘Mother’s Room’ at its office in October last year, with the aim of fostering an inclusive and supportive workplace environment. Dr. Diane Karusisi, CEO Bank of Kigali, said that they envisage building a mothers’ room in all of their branches and workplaces to support breastfeeding mothers. “So far, we have done the Headquarters and 3 branches. We also offer a longer maternity leave of 4 months to support mothers taking care of their babies,” Karusisi said, in reference to the room which offers a range of features designed to support mothers in balancing their professional and parenting responsibilities. The mothers’ room at BK includes a fully equipped kitchen, a dedicated private breastfeeding area, baby’s cribs, and a pumping booth, among other things. Jacqueline Nkwihoreze, the chair of BK’s gender equality committee, said they are doing this to support gender equality and equity initiatives by the Government of Rwanda, where workers in both public and private sector have to work in conducive environments. “As players in the economy and the private sector, we are here not only to support initiatives that the government puts in place to improve the quality of life of the people, but also to ensure that we take the lead, beginning with our own staff,” “As a bank, we have several initiatives to support gender equality and that is just one of them. We want to ensure that nursing mothers who work with BK don’t have any challenge breastfeeding their babies at work,” Nkwihoreze said. Prossie Kalisa, Access Bank Rwanda Executive Director for Retail and Digital Banking, says supporting breastfeeding in the workplace has significant human and economic benefits in the workplace. Kalisa says that it has been proved that when companies or organisations encourage mothers to breastfeed while at work is of significant importance because it substantially improves the health of the mother and of course that of the child. “As we all know, breast milk protects the child from infectious diseases, especially digestive and respiratory infections. Studies have proven the fundamental role of breastfeeding in significantly preventing non-communicable diseases, such as obesity and type 2 diabetes,” “I would like to encourage institutions to come up with initiatives that do bring breastfeeding mothers to get closer with their children, by way of supporting them either to pump or having private places such as breastfeeding rooms,” Kalisa says. She advises a wide range of ways which can bring a greater balance between breastfeeding and work, including allocating time and flexibility to work for breastfeeding mothers and such incentives come with benefits for both the employee and company. Among other things, she says putting in place facilities for breastfeeding mothers increases productivity because the mother is stable and motivated at work, reduces employee turnover as well as many other socioeconomic benefits which have a positive impact at work. Kalisa argues that when such facilities or flexibility is in place, employees don’t only feel appreciated and recognised but also the absences at work and requests for permission to see the doctor tremendously decline. Sylvie Nsanga, a women rights activist and care work advocate says that the biggest challenge breastfeeding women face at work today is lack of facilities to sustain breastfeeding post maternity leave. Nsanga says that lack of sufficient knowledge and awareness, absence of support systems and difficult work conditions are the other reasons that hinder breastfeeding at work in most African countries and elsewhere. “In the past, we had mothers and aunties who were living nearby or present, to pass on the traditional knowledge they had but today these practices have disappeared,” she argues. “You are either on your own, or with your husband and siblings who also don’t have the knowledge. So, for many reasons, you find that breastfeeding cannot be sustained because of that or lack of tools and equipment,” Nsanga adds. She argues that in most cases, expressing breast milk is for the elite who can afford the equipment, including pumps, bottles and cold storage while the less privileged people doing ordinary jobs cannot afford such. Nsanga attributes lack of knowledge to false beliefs related to breastfeeding, such as breastfeeding increases the size of breasts or leads to gaining wait, which lead to babies being weaned off breastfeeding early. Nsanga says that there is a need for the concerned institutions to create more awareness on breastfeeding, to dismantle the stereotypes around it and to ensure that all employers put in place facilities that encourage breastfeeding at work. She adds that public breastfeeding rooms need to be put in place to enable women to breastfeed wherever they are and also revise the structural set up of how things work to accommodate breastfeeding as a human right. Nsanga argues that it is high time breastfeeding is given its rightful place and importance, including availing the necessary knowledge, because in most cases women who don't breastfeed equally face negative consequences, including health conditions such as mastitis. Advancing breastfeeding at work is a duty Nsanga believes should not be seen in the sense of helping a woman, but rather a responsibility the society has, and that involves policymakers, employers and the society at large.

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When the baby pays the price: Navigating the rigours of breastfeeding at work